Health policy analysts explain why U.S. has staked out a different position

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Note that this perspective in the New England Journal of Medicine highlights the view in Great Britain that e-cigarettes may be a useful public health tool to aid in smoking cessation.

Be aware that the counterpoint to this view suggests that e-cigarettes might act as a gateway to smoking for nonsmokers.

The predominant view of U.S. health officials is that e-cigarettes pose a threat to public health, but high profile health groups in the U.K. are saying e-cigs should be recommended for smoking cessation and harm reduction.

Public Health England (PHE), a group made up of health specialists from more than 70 organizations in the U.K., released an independent review of the evidence that evaluated e-cigarettes and health. The report from summer 2015 concluded that e-cigarettes were around 95% less harmful than combustible cigarettes and that there is, as yet, no evidence to suggest they are gateway products to smoking.

Epidemiologist Sharon Green, MPH, and colleagues from Columbia University in New York City questioned whether the PHE report, and the acceptance of its conclusions by other public health groups in the U.K., will ultimately reframe the public policy debate about e-cigarettes in the U.S.

"Strikingly, the [PHE] report underscored e-cigarettes' potential to address the challenges of health inequalities, a central mission of PHE, stating that these devices 'potentially offer a wide reach, low-cost intervention to reduce smoking and improve health in these more deprived groups in society where smoking is elevated,'" they wrote in a perspective in the New England Journal of Medicine.

Green's group argued that the difference in how health officials in the U.K and the U.S. view e-cigarettes reflects a longstanding difference in their perspective on public health -- policymakers across the pond focus on reducing harm, while those in the states favor an approach that minimizes risk through prohibition and abstinence.

"Here in the U.S. we tend to focus on keeping children and non-smokers from using these devices," Green told MedPage Today. "In the U.K., they tend to prioritize the burden of cigarette smoking, which is tremendous. According to the World Health Organization, smoking kills approximately 6 million people a year."

She said this difference in attitudes helps explain why U.K. health officials seem more willing to view e-cigarettes as a tool for helping smokers quit.

John Moxham, who chairs the U.K.'s anti-tobacco lobbying group Action on Smoking and Health (ASH), is one of those officials.

"There is really very little evidence that e-cigarettes are a gateway drug to tobacco use," Moxham told MedPage Today, adding that the survey suggested that the uptake of e-cigarettes by children not already smoking cigarettes was around 0.02%.

He said while some public health groups and individual policymakers in the U.K. have been critical of the PHE report, others, including the British Thoracic Society, accept the idea that e-cigarettes may be beneficial smoking cessation tools.

"My judgment, and the judgment of many others in this country, is that the potential benefits far outweigh the potential problem of e-cigarettes being a gateway product to smoking, which they don't appear to be," he said.

Moxham added that the fact that e-cigarettes are often manufactured and marketed by the same companies that sell combustible cigarettes may also help explain why public health officials view them so negatively.

"I dislike the tobacco industry," he said. "I have spent many years campaigning against them, and I can see that it may be problematic for public health to embrace a product that they sell."

Like ASH in Great Britain, the Campaign for Tobacco Free Kids in the U.S. is leading the fight to reduce tobacco use, and the group has repeatedly called for e-cigarettes to be regulated by the FDA.

In a blog post published last fall, campaign President Matthew L. Myers wrote that effective oversight of e-cigarettes by the FDA is essential for understanding their potential risks and benefits.

"If there is a public health benefit to the emergence of e-cigarettes, it will only come if they are effective at helping smokers end the use of cigarettes and if they are marketed in a way that prevents the re-glamorization of smoking among young people," he wrote.

Vince Willmore, who is vice president of communications for the organization, told MedPage Today that the current marketing of e-cigarettes is a major concern.

"These products are being marketed using the same tactics once use to sell cigarettes to kids, including celebrity endorsements, slick magazine ads, and sponsorship of auto racing and concerts," he said. "We need the FDA to take action to prevent the marketing and sale of these products to kids and to evaluate the evidence to help determine if e-cigarettes can really help smokers give up cigarettes."

Greene's group asked if the PHS report will change the international conversation about e-cigs.

"The answer will depend, in part, on what the evolving evidence suggests, and it may take years before the answers are definitive," they wrote.

Greene and co-authors disclosed no relevant relationships with industry.

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